Idaho CareLine: In Idaho, Dial 2-1-1 or 800-926-2588

 

 

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 Perinatal Substance Use:
Is She at Risk?

The Fact Is … In 1996, one in 7 Idaho babies was born to mothers who reported smoking during pregnancy.* Cigarette smoking is the largest and most important known modifiable risk factor for low birth weight and infant death. Exposure to secondhand smoke leads to reduced infant weight only slightly less than if the mother smoked. In 1996, 479 Idaho babies were born to mothers who reported alcohol use during pregnancy.* Moderate to heavy alcohol use by women during pregnancy has been associated with severe adverse effects in children, including fetal alcohol syndrome. Alcohol use by pregnant women is the leading known preventable cause of mental retardation in newborns. 12.4 percent of childbearing-age women in Idaho reported frequent use of alcohol (an average of seven or more drinks per week or five or more drinks on at least one occasion in the preceding month).** Early prenatal exposure to alcohol can occur unintentionally before a woman knows she is pregnant. Women who drink at high levels before pregnancy are more likely to drink during pregnancy. It is estimated that 4.4 percent of women in Idaho have used illicit drugs during pregnancy.***

Perinatal substance use refers to use of any substance during pregnancy that is known to have a harmful effect on the fetus. It includes the use of legal drugs — alcohol, tobacco, and prescription drugs — and illegal drugs.

Smoking increases the risk of having a low birth weight baby. Smoking during pregnancy has been linked to 20 percent to 30 percent of low birth weight births (under 5 1/2 pounds) and 10 percent to 30 percent of fetal and infant deaths. Cigarette smoking is unequivocally the largest and most important known modifiable risk factor for low birth weight and infant death. It also increases risk for:

• Miscarriage, prematurity, and still births;
• Sudden Infant Death Syndrome (SIDS); and
• Respiratory infections for the first year after birth, including pneumonia, bronchitis, asthma, recurrent colds, and ear infections.

Alcohol use during pregnancy has long been associated with both short- and long-term negative health effects for infants. Alcohol abuse during pregnancy clearly is related to a series of congenital malformations described as fetal alcohol syndrome (FAS). Heavy alcohol consumption has been cited as the leading cause of mental retardation worldwide.

FAS is characterized by a pattern of severe birth defects which include prenatal and postnatal growth retardation, central nervous system disorders, and distinct abnormal craniofacial features. Children whose mothers drank heavily during pregnancy also may exhibit a number of developmental problems, including hyperactivity, short attention spans, language dysfunctions, and delayed maturation.

The possible effects of prenatal drug exposure on the infant include intrauterine growth retardation and neurobehavioral dysfunction. Prenatal cocaine and heroin abuse have been associated with adverse birth outcomes. Women who use cocaine during pregnancy are possibly at increased risk of preterm delivery. Both cocaine and methamphetamines can cause constriction of the blood vessels. This results in decreased blood flow (nutrients and oxygen) from the mother to the fetus, resulting in low birth weight, small head size, and prematurity. These drugs can be related to higher rates of miscarriage, abruptio placenta (detachment of the placenta from the uterine wall leading to internal bleeding — a medical emergency), and SIDS.

A small percentage of mothers who use cocaine during the first three months of pregnancy, as well as those who use it throughout pregnancy, have been found to have infants who show significant impairment in their ability to orient and their muscular control. Some methamphetamine- and cocaine-exposed infants exhibit poor state regulation, tremors, irritability, poor sucking and swallowing reflexes, muscular hypertonicity, and a high-pitched cry.

Other factors in a drug user’s lifestyle, including malnutrition, sexually transmitted diseases, and polysubstance abuse, may contribute to an increased risk of adverse pregnancy outcome. Effects of substance use on the fetus may not be limited to mother’s use. Paternal alcohol consumption may have an affect on fetal development. Research relative to the paternal effects of alcohol on progeny are still in a very early state of development.

Effects on the Family

The demanding behavioral characteristics of infants prenatally exposed to drugs make caring for them very difficult. The usual comforting actions often do not work, and even experienced caregivers find caring for these infants exhausting. Special support is necessary for these fragile infants and their vulnerable mothers. The mother’s chaotic and insecure lifestyle and past lack of nurturing combine with her infant’s difficult behaviors and medical problems to create a scenario in which child neglect and abuse are likely.

Many experts in infant development now believe that the most important factor for drug exposed infants is the establishment of an essential trusting bond of attachment with their parents or caregivers in the earliest months. Practices and policies that separate mothers from their infants serve to intensify obstacles to the bonding process.

The vast majority of substance abusing pregnant women have parents who themselves were substance abusers, a phenomenon that has been especially well-documented with regard to smoking and alcoholism. Individuals raised under such conditions have a high probability of becoming substance abusers, carrying the problem into the next generation.

Role of Community, Health, and Social Service Providers

What Works in Families If you are pregnant or could become pregnant: Choose NOW to avoid all use of alcohol, tobacco and other drugs. IT’S NEVER TOO LATE TO QUIT! Begin prenatal care early and continue throughout pregnancy Seek help in becoming substance-free If you know someone who is pregnant or could become pregnant: Support her in a lifestyle free of alcohol, tobacco, and other drugs Help her avoid secondhand smoke What Works in Your Community Become involved in a substance abuse prevention coalition Educate others about the hazards of substance use during pregnancy avoiding guilt inducing messages Support the availability of comprehensive services for women and children including health care, social services, substance abuse treatment, and parenting support Encourage public policy and practices that support behavior change in women who use alcohol, tobacco, and other drugs

Women’s substance abuse is often ignored by medical practitioners and society, as if looking the other way will spare women from the stigma of identification. Instead, this "politeness" abandons them to ignorance and continued progression of the disease. Researchers have found that women will respond honestly to objective, empathic questions, but will not voluntarily report substance abuse.,

Health and social service providers who provide services for pregnant women have a unique opportunity to identify women at-risk for alcohol, tobacco or other drug use and to initiate appropriate interventions. Pregnancy is a natural time for women to connect with service providers and the goal of having a healthy baby is generally a strong motivator.

Women can enter the system from a variety of settings, including hospital emergency rooms and obstetrical units, community health centers, family planning clinics, or social service offices. It is essential to be able to offer screening, care coordination, and referral services from any or all of these settings.

Ethical and Legal Obligation

Many care providers, out of haste, ignorance, discomfort, or cynicism do not spend the time necessary to identify substance use or to appropriately counsel mothers. Given the tragic consequences of substance use during pregnancy, every provider caring for pregnant women has an ethical obligation to identify substance use, to counsel against its use, and to refer women who are substance abusers to treatment. Failure to do so may have legal consequences if there is a negative outcome that could have been prevented with appropriate treatment.

Child Abuse Reporting

Under Idaho law, professionals and all other people have a responsibility to report to the proper law enforcement agency or the Idaho Department of Health and Welfare, within 24 hours, if they have reason to believe a child has been abused, abandoned or neglected, or if they have observed the child being subjected to conditions or circumstances which would reasonably result in abuse, abandonment or neglect.

The Idaho Department of Health and Welfare has taken the position that if it receives a report of a pregnant substance-using woman, it is generally unable to intervene prior to the birth of the child. However, if a pregnant woman has other children in her custody, a report is indicated if the care provider has reason to believe that substance use is impairing the mother’s ability to adequately care for her child or children resulting in abuse, neglect, or abandonment.

Link Between Substance Abuse and Neglect Substance abuse by parents plays a major part in child protection referrals. In fact, studies show that substance abuse negatively affects the ability of parents to love and care for their child. It may cause a parent to be less responsible for their child’s needs. Substance abuse may shorten the parent’s patience or cause the parent to use poor judgement. Oftentimes, parents use money for alcohol or drugs instead of food, clothing, and other basic needs. A child of substance abusing parents can be at risk of harm because his/her parents are manufacturing, selling, or using drugs. See: "Be the Parent Your Child Needs."

What to Do  Step 1: Ask  

Who Should Be Screened?

BECAUSE substance use and abuse patterns exist across social and economic class boundaries, across racial and ethnic groups, and amongst urban and rural populations;

BECAUSE impaired thinking patterns of denial, minimization and rationalization are cornerstones of the pattern;

BECAUSE the pattern exists along a developmental continuum whose earlier stages may be characterized by low visibility of symptoms;

BECAUSE the majority of pregnancies are unplanned;

BECAUSE use during pregnancy creates risk for adverse fetal development;

• ALL PREGNANT WOMEN,
• ALL WOMEN CONTEMPLATING OR PLANNING PREGNANCY,
• ALL WOMEN AT RISK FOR PREGNANCY BECAUSE OF HIGH RISK BEHAVIOR, AND
• ALL OTHER WOMEN OF CHILDBEARING AGE, INCLUDING TEENS AND PRETEENS…

SHOULD BE screened for problems or risk of developing problems;

SHOULD BE informed and educated about the risks of perinatal substance use; and

SHOULD BE offered support and assistance in accessing appropriate resources for treatment.
 

Summary: The problem of tobacco, alcohol, and other drug use during pregnancy is an issue that concerns people throughout Idaho. Health care providers witness the effects of prenatal exposure to substances on newborns. Child welfare service providers become involved when substance use impacts parents’ ability to care for and nurture their child. Educators experience frustration when affected children display behavioral problems which disrupt the classroom, or when neuralgic impairment precludes learning. Taxpayers feel the effects as increased revenues are needed to provide for special services for affected children.

The best resolution to the problem is to prevent and/or treat substance use before women get pregnant, or at the very least, while they are pregnant, in order to minimize fetal exposure. Early intervention during the prenatal period is highly desirable for the health of the woman and her fetus, for the infant after birth, and for the initiation of alcohol and other drug treatment for the mother and her family.

The above information is taken from a packet developed by the Screening Protocol Workgroup of the Idaho Perinatal Substance Use Prevention Project. The packet was developed to serve as a resource for service providers who interface with pregnant or potentially pregnant women. To receive a complete packet or for further information, contact the Idaho Regional Alcohol/Drug Awareness Resource Center (RADAR)  via e-mail: RADAR@boisestate.edu or call 1-800-937-2327.  Contact the Idaho CareLine for the telephone number of your local substance abuse treatment care managers to learn about treatment resources. 

The goal of the full packet is to raise your awareness and to provide you with information and resources about:

• An overview of perinatal substance use issues;
• The screening for and identification of substance use during pregnancy;
• The skills and strategies for taking appropriate action steps for intervention and/or referral; and
• Legal confidentiality and reporting issues.

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Additional Articles/Resources

(Note: You'll find these articles at different web sites. Use the "back" button when you're done to return to this page.)

National Clearinghouse for Alcohol and Drug Information, 1-800-729-6686
   
Idaho Regional Alcohol/Drug Awareness Resource Center(RADAR). Located in Idaho and they have most of the NCADI materials in stock and can ship them within 5 working days. Copies of "Is She at Risk?" folder can be requested via e-mail: RADAR@boisestate.edu or call 1-800-937-2327. 

Idaho Department of Health & Welfare, Division of Behavioral Health, Boise, Idaho, (208) 334-6997.

Idaho March of Dimes, Boise, ID, (208) 336-5421.

National Association for Families and Addiction Research and Education (NAFARE), (312) 431-0013

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Footnotes:

* 1996 Birth Certificate Reporting, Center for Vital Statistics and Health Policy, Idaho Department of Health and Welfare, NOTE: Smoking and alcohol use are believed to be underreported on birth certificates.
** 1995 Behavioral Risk Factor Surveillance System, U.S. Department of Health and Human Services, Public Health Service.
*** 1992 National Pregnancy and Health Survey, National Institute of Drug Abuse (Figures based on reported use by white mothers in a national sample assumed to be similar to Idaho’s population).